title: Aortic stiffness in lone atrial fibrillation: a novel risk factor for arrhythmia recurrence.
abstract: BACKGROUND
  Recent community-based research has linked aortic stiffness to the development of atrial fibrillation. We posit that aortic stiffness contributes to adverse atrial remodeling leading to the persistence of atrial fibrillation following catheter ablation in lone atrial fibrillation patients, despite the absence of apparent structural heart disease. Here, we aim to evaluate aortic stiffness in lone atrial fibrillation patients and determine its association with arrhythmia recurrence following radio-frequency catheter ablation.
  
  
  METHODS
  We studied 68 consecutive lone atrial fibrillation patients who underwent catheter ablation procedure for atrial fibrillation and 50 healthy age- and sex-matched community controls. We performed radial artery applanation tonometry to obtain central measures of aortic stiffness: pulse pressure, augmentation pressure and augmentation index. Following ablation, arrhythmia recurrence was monitored at months 3, 6, 9, 12 and 6 monthly thereafter.
  
  
  RESULTS
  Compared to healthy controls, lone atrial fibrillation patients had significantly elevated peripheral pulse pressure, central pulse pressure, augmentation pressure and larger left atrial dimensions (all P<0.05). During a mean follow-up of 2.9±1.4 years, 38 of the 68 lone atrial fibrillation patients had atrial fibrillation recurrence after initial catheter ablation procedure. Neither blood pressure nor aortic stiffness indices differed between patients with and without atrial fibrillation recurrence. However, patients with highest levels (≥75(th) percentile) of peripheral pulse pressure, central pulse pressure and augmentation pressure had higher atrial fibrillation recurrence rates (all P<0.05). Only central aortic stiffness indices were associated with lower survival free from atrial fibrillation using Kaplan-Meier analysis.
  
  
  CONCLUSIONS
  Aortic stiffness is an important risk factor in patients with lone atrial fibrillation and contributes to higher atrial fibrillation recurrence following catheter ablation procedure.
authors.affiliation: Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Lau
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Middeldorp
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Brooks
authors.forename: Anand N
authors.initials: AN
authors.lastname: Ganesan
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Roberts-Thomson
authors.forename: Martin K
authors.initials: MK
authors.lastname: Stiles
authors.forename: Darryl P
authors.initials: DP
authors.lastname: Leong
authors.forename: Hany S
authors.initials: HS
authors.lastname: Abed
authors.forename: Han S
authors.initials: HS
authors.lastname: Lim
authors.forename: Christopher X
authors.initials: CX
authors.lastname: Wong
authors.forename: Scott R
authors.initials: SR
authors.lastname: Willoughby
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Young
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.forename: Walter P
authors.initials: WP
authors.lastname: Abhayaratna
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology / Q000503:physiopathology*; D062186:Arterial Pressure; D001281:Atrial Fibrillation / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness